Joint Research Ethics Board

The Salvation Army Toronto Grace Health Centre (TGHC) is a partner on the Joint Research Ethics Board (JREB) along with Bridgepoint Active Healthcare, West Park Healthcare Centre and the Toronto Central Community Care Access Centre.

The JREB exists to ensure that all research involving human subjects conducted under the auspices of these institutions meet the highest scientific and ethical standards.

Ethics are principles of right conduct guiding ‘what ought to be done”. In the context of the Tri-Council Policy Statement: Guidelines on Research Involving Human subjects, the JREB subscribes to the following ethical principles that are commonly held and valued by diverse research disciplines:

1. “Improving the Medical Management of Patients at the Toronto Grace Health Centre Using the New interRAI Clinical Assessment Instruments and Applications”. The Principal Investigator is John Hirdes, PhD, University of Waterloo, Pubic Health and Health Systems, and Co-investigators are Nancy Curtin-Telegdi, MA, University of Waterloo, Pubic Health and Health Systems, Leslie Eckel, MSW, University of Waterloo, Pubic Health and Health Systems, and the Student Investigator is Luke Turcotte, University of Waterloo, Public Health and Health Systems.

This is a collaborative project between The Salvation Army Toronto Grace Health Centre (TGHC) and the University of Waterloo. The purpose of this project is to introduce the new interRAI Clinical Assessment Protocols into practice and establish the RAI 2.0 as a clinical tool at TGHC. Several activities are expected to take place for this project, including:

Enhancing the clinical use of the RAI 2.0 instrument in Toronto Grace Health Centre by:

Training staff on the clinical applications of the instrument through a cross-disciplinary educational program including nursing, allied health professions, and medicine;

Introducing the new interRAI Clinical Assessment Protocols (CAPs) into all care planning and clinical team activities in the hospital;

Improving the continuity of care between Toronto Grace Health Centre and the Toronto Centre Community Care Access Centres by incorporating previous RAI-Home Care assessments done by the CCAC into the clinical record for new admissions in Toronto Grace;

Improving the hospital’s IT system to support better clinical use of the interRAI instruments; and

Moving to a paperless integrated clinical system to improve clinical care, reduce duplication of non-value added work, and improve communication between disciplines.

2.“Effectiveness of the buccal mucosa route for methadone administration at end of life.” The Principal Investigator is Dr. Donna Spaner, Clinical Director, Palliative Care Program. This study is a retrospective chart review.

Methadone is a strong opioid with significant analgesic properties that have made it useful for the control of moderate to severe pain in palliative care. Primarily administered by the oral route, methadone can be problematic in the final days of life when many terminally ill patients lose the ability to swallow oral medications. It is customary on our Palliative Care Unit is to switch patients on oral methadone in the final days of life to the buccal mucosa route. Methadone appears to be well tolerated and efficacious by this route. However, there is little available evidence to support this practice and guidelines for methadone use when the patient can no longer swallow in the final days of life would be useful. The present observational study will use a retrospective cohort design to investigate whether the analgesic efficacy of methadone by the buccal mucosa route is comparable to the more commonly used subcutaneous hydromorphone.

Dysphagia, or difficult in swallowing, presents many challenges to the act of drinking and eating. In the palliative care setting, patients often will develop dysphagia at the end stages of life.

The objectives of this study are to:

Understand the beliefs, attitudes and values of a caregiver and how these influence the responses of a caregiver to diet modifications of a patient with dysphagia, using a qualitative interview.

Identify potential barrier(s) that may hinder the acceptance of dietary modifications to a patient in palliative care.

Review/estimate the prevalence of palliative patients on the unit who have dysphagia. Estimate the prevalence of compliance with dietary modifications by caregivers.

4. “Clinical Profiled and Trends in Health System Use of Complex Continuing Care Patients in the Community Prior to Admission to The Salvation Army Toronto Grace Health Centre.” The Co-investigator are John Hirdes, PhD, University of Waterloo, Pubic Health and Health Systems, Dr. George Heckman, University of Waterloo, Pubic Health and Health Systems, and the Student Investigator is Chi-Ling Joanna Sinn, University of Waterloo, Pubic Health and Health Systems.

In Ontario, interRAI instruments are used in most care settings, including complex continuing care hospitals and home care agencies. The elderly are the focus of care transitions research because they often require care from different providers across various settings; however, most of the research centres on transitions from acute hospitals to home, and transitions to long term care only. This study will describe patients who enter complex continuing care from the community (often through acute care). This study will use data from the interRAI family of instruments (and establish linkages to other administrative data sources) to develop a clinical profile and examine patterns of health and social service use prior to admission. This study will also investigate the consistency of information between the referral and the admission assessment, and identify any missing indicators on the assessments. The evidence obtained about the patient trajectory will transform record-keeping data into data for care planning and inform upfront case management in hospital. Ultimately, patients will benefit from greater continuity of care based on information from previous care settings.